PROJECT SUMMARY/ABSTRACT - Decision Making for Social Distancing Globalization, changing human behaviors and the emergence of new pathogens create an ongoing vulnerability to disease threats. In the early days of communicable disease outbreaks or pandemics, social distancing tools may be the only interventions available to public health officials to mitigate the spread of disease. State and local public health officials' use of social distancing tools in infection control varies widely, even when these measures may limit morbidity and mortality. Instituting social distancing requires legal authorities and financial resources, and may also be impacted by evidentiary standards, risk assessments, political will, and community and individual support. It is unclear exactly how these factors influence public health officials when making decisions to use social distancing tools or if any of these factors can be predicted. Yet, this knowledge is essential to understanding what actions are most likely to be instituted during a public health emergency and to target interventions to better prepare health departments to enact social distancing measures when necessary. The specific aims of the proposed research are: 1. To conduct case studies of health department experiences with tuberculosis (TB) isolation. We will conduct in-depth interviews and literature analysis to construct a series of case studies associated with local and state decisions to isolate TB patients. This case study analysis will identify variation in legal authorities, political will, and evidentiary standards that will be essential to understanding how states and localities will respond during a pandemic or other public health emergency. 2. To assess the decision making process associated with social distancing. We will examine existing laws, country demographic characteristics and previous experience with both H1N1 and tuberculosis, and conduct a survey of local and state public health officials. We will then identify major challenges, inputs, and decision points that can then be targeted to facilitate informed risk assessments and actions. 3. To determine predictive factors associated with decision making for social distancing. We will use latent class analysis, cluster health departments into groups along similar key variables, and assess how these departments make social distancing decisions by looking at potential predictors. These findings will help target public health interventions more effectively.